Electronic prompts could improve antibiotic selection for pneumonia

Pneumonia remains the most common infection-related condition that lands U.S. patients in the hospital. Identifying strategies to curb antibiotic overuse for those hospitalized with pneumonia continues to be a national priority.

Based on results that compared the effect of a computerized provider order entry (CPOE) antibiotic stewardship bundle versus routine stewardship on antibiotic selection for noncritically ill pneumonia patients during their first 3 days in the hospital, researchers of a new study published in JAMA found that the group using CPOE prompts had a 28.4% reduction in empiric extended-spectrum days of therapy. Hospital length of stay and days to ICU transfer were unchanged.

“Currently, clinicians often prescribe vancomycin and/or antipseudomonal therapy for pneumonia at admission and deescalate to standard-spectrum antibiotics if nasal screening test results are negative for methicillin-resistant Staphylococcus aureus (MRSA) or if cultures do not reveal Pseudomonas or other MDROs [multidrug-resistant organisms],” study authors wrote. “Although most inpatients with pneumonia can be safely treated with standard-spectrum antibiotics, which do not cover Pseudomonas or MDROs, clinicians are reluctant to initially select them because of concern that the patient may be infected with an MDRO.”

Researchers evaluated data from 59 hospitals with 96,451 adult patients admitted with pneumonia to determine whether CPOE prompts that provided patient- and pathogen-specific MDRO infection risk estimates for pneumonia patients could reduce empiric extended-spectrum antibiotics.

Secondary outcomes of vancomycin and antipseudomonal days of therapy showed similar reductions, according to the findings.